Can't take an anti-inflamatory for 4 moths or so !!!

[littlecaddis1 .]

My usual gout medication is Diclofenac 50mgs. and it usually works. I am now on Warfarin which is a blood thinner and cannot take the diclofenac as it is also a blood thinner. Any suggetions as what I could subsitute it with ?

[Keith Taylor]

Diclofenac isn’t a specialist gout medicine. It’s just an anti-inflammatory that can help your gout pain until you get uric acid under control.

I’ve got lots of suggestions, but I don’t want to waste your time with alternatives to diclofenac that are not relevant to your particular situation. How about a bit more information so I can help you better? Your profile is a good place to start, as it’s completely empty at the moment.

Also, it’s important to consider other health issues that can complicate gout treatment. I’m worried that whatever you need to take warfarin for will impact your best gout treatment.

I look forward to getting some more facts about your gout and your health in general. Then we can get together a plan to stop gout ever coming back. It’s very important to do this, as gout will only get worse if it’s not treated properly.

[littlecaddis1 .]

Thank you for getting back. I did my profile but guess I didn’t save it. I have now updated My profile. The reason I am on Warfarin is that I have blood clot in my arm
and they are trying to disolve it and it may take 3-4 months or so. I slowly started getting gout ( I know it usually comes on fast but witj me I can usually tell
a day or so before that an attack is coming ) about 8 days ago and would have immediately taken my meds but could not so I just had to let it run its course. The most
pain I’ve been in for several years !! It has lessened now and will see my Dr today. He has suggested Colchicine but I understand this is only good at the intial attack of gout or within 48 hours ? I would like to go on Allaperone (?) but don’t want to start anything like that until I am able to take my diclofenac as I understand I could easily get an attack or 2 when starting the Allaperone.

So yeah…. any comments or suggestions from anyone would really be a big help.

Regards george

[Keith Taylor]

I’d normally recommend starting allopurinol, or other uric acid lowering treatment. But your’s is a special case. I understand why you want to wait before starting allopurinol. Lowering uric acid to 300 μmol or lower is the best thing lomg-term, as it causes old uric acid crystals to dissolve. Once thy are gone, you can’t get gout attacks. But that takes a few months, so you are at risk. There are still a couple of points to consider though:

1. You might get gout attacks anyway, and the chances of this increase as uric acid remains high.
2. Taking colchicine alongside allopurinol usually prevents gout attacks.

Now, nobody knows if you will get more attacks or not, so you have to weigh things up, discuss them with your doctor, then decide if it’s right to try allopurinol soon, or after you get the blood clot sorted out. There’s no right or wrong answer – just whatever suits you best.

You are right that colchicine isn’t much good once a gout attack has become established. It’s best to think of it as a way to reduce your risk of a gout attack in future.

Even with colchicine, I usually recommend to keep other pain killers on hand, just in case colchicine isn’t enough. There has been a suggestion that salsalate is compatible with warfarin. However, it’s not a good choice for gout patients, as it interferes with uric acid excretion. The other option is to consider pain blockers that have no anti-inflammatory component, but are compatible with warfarin. It could well be that a combination of colchicine and a pain blocker will keep pain tolerable without compromising your warfarin.

George, it’s probably best to discuss these options with your doctor. Anyway, whatever you decide, I hope you’ll keep us all updated with your progress.

[littlecaddis1 .]

Keith : Thank you very much. Since starting with this site my knowledge and appreciation of gout has increased substantially.
I am discussing all these items with my Dr. and would not undertake any substantial self medication or without his knowledge.

What are your thoughts about taking Colchine for say as long as, you/we/dr (tests), it takes for my uric acid to drop substantially . The literature Ihave read on this drug makes me a tad uneasy /

Regards George

[Keith Taylor]

George, I think it’s right to be very careful, and think hard before you decide. In my own life, I spent years deciding what to do.

I was nervous about any form of medication, but I finally realized that my failure to act was far worse than most potential allopurinol side-effects. When I considered my situation, I learned that all potential risks could be minimized with careful planning.

So it is with colchicine.

To be blunt, colchicine is a poison, so it’s good to be wary. I found it very tolerable and effective. It is important not to exceed 2 colchicine pills in 24 hours. It is also important to be aware that your immune system is compromised by colchicine. That means avoiding exposure to infections, or stopping colchicine if you are exposed. I suggest that the perfect plan would be to try colchicine 2 days before the planned start of allopurinol. If you can tolerate it, proceed with allopurinol. If not, think again.

In my view, it’s always best to go as low as possible with uric acid during the first few months. That gets rid of old crystals quicker, thus reducing the gout attack risk period, and minimizing the time you need to take preventative colchicine.

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